Nerve Damage May Explain Chronic Pain in Children

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Patients seen for chronic pain had test results indicating small-fiber polyneuropathy

By Lisa Davis

Could a newly identified disease explain some cases of chronic pain and other symptoms in children and young adults? According to a paper in the April issue of the journal Pediatrics, researchers led by Dr. Anne Louise Oaklander, director of Massachusetts General Hospital’s nerve injury unit, found that young patients seen for chronic, unexplained pain had test results indicating small-fiber polyneuropathy (SFPN), a condition not previously reported in children. Researchers call this new syndrome juvenile-onset small-fiber polyneuropathy.

SFPN involves widespread damage to the type of nerve fibers that carry pain signals from the skin. Typical symptoms include chronic pain, often emanating from the feet or lower legs, along with symptoms of autonomic dysfunction such as gastrointestinal problems, dizziness or fainting when standing, rapid heart rate, and changes in the appearance of skin.

Researchers reviewed the records of 41 patients who were treated for widespread pain before the age of 21. All had diagnostic tests, including several recommended for SFPN. An analysis of the results found that 24 of the 41 patients met the criteria for a diagnosis of SFPN, meaning that at least one test indicated the presence of the disease. Sixteen of the remaining 17 patients were determined to possibly or probably have SFPN, based on abnormal test results.

Doctors at MGH will now take a two-part approach to evaluating chronic pain in children, Oaklander said. A neurologist will evaluate patients for SPFN; if the condition is confirmed, specific blood tests will be given to help pinpoint the cause.

We’ve found the beginnings of a way to better evaluate young patients with otherwise unexplained widespread body pain, Oaklander said. By identifying the tests that are useful for diagnosing this condition, we hope to reduce the use of unnecessary, expensive, sometimes painful and potentially harmful testing that many of these children have undergone.

Is your child in pain? Learn how you can help. Whether the condition is new or ongoing, Mom, It Hurts offers advice from pediatric experts on how to manage a kid’s pain.

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